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Posts from the ‘Harm reduction’ Category

“Welfare day” in British Columbia

Today I’m releasing the results of an FOI request I submitted several years ago, before last provincial election in British Columbia. It provides insight into what the previous government knew about the harms of “cheque day,” also known as “welfare day,” or “welfare Wednesday.” This is the one day of the month in British Columbia when the vast majority of funds are distributed to individuals who qualify for income assistance and/or disability assistance.

This was my request:

All records related to Income Assistance and Disability Assistance cheque issue dates including but not limited to: government communications and policy decisions regarding cheque issue dates; internal discussions about the 2014 study from the BC Centre for Excellence in HIV/AIDS that links “cheque day” with increased illicit drug overdoses:

and any policy changes suggested around the new date schedule, any government communication with external groups about the study, and any previous or subsequent internal government research about this; any government communications, emails, memos, notes, etc, regarding the new research underway known as TASA Cheque Day:

; all records associated with the change to public notification of cheque issue dates for the current year when prior to 2015, government made the past 5+ years of cheque issue dates available on its website. (Date Range for Record Search: From 01/01/2013 To 01/24/2016)

Here are the results of the above FOI request.

It is worth noting that ever since 2016, the British Columbia government only gives public notification of the Income Assistance and Disability cheque issue dates for the current year (presently, 2018).

However, prior to late 2015, the BC government always made at least five years of cheque issue dates available on its web site, as shown by the Wayback Machine internet archive. (If you follow the above link you may have to scroll down to see the actual cheque schedules.) I’ve included the last available five year schedule of the cheque dates below for anyone who is conducting research in this area:

Income Assistance and Disability Assistance Cheque Issue Dates

2015 Schedule
For the month of     ->     Cheque issue date
January 2015     ->     December 17, 2014
February 2015     ->     January 21, 2015
March 2015     ->      February 18, 2015
April 2015      ->      March 25, 2015
May 2015      ->      April 22, 2015
June 2015      ->      May 27, 2015
July 2015      ->      June 24, 2015
August 2015      ->      July 29, 2015
September 2015      ->      August 26, 2015
October 2015      ->      September 23, 2015
November 2015      ->      October 21, 2015
December 2015      ->      November 18, 2015
January 2016      ->      December 16, 2015

2014 Schedule
For the month of      ->      Cheque issue date
January 2014      ->      December 18, 2013
February 2014      ->      January 22, 2014
March 2014      ->      February 26, 2014
April 2014      ->      March 26, 2014
May 2014      ->      April 23, 2014
June 2014      ->      May 28, 2014
July 2014      ->      June 25, 2014
August 2014      ->      July 23, 2014
September 2014      ->      August 27, 2014
October 2014      ->      September 24, 2014
November 2014      ->      October 22, 2014
December 2014      ->      November 19, 2014
January 2015      ->      December 17, 2014

2013 Schedule
For the month of      ->      Cheque issue date
January 2013      ->      December 19, 2012
February 2013      ->      January 23, 2013
March 2013      ->      February 20, 2013
April 2013      ->      March 20, 2013
May 2013      ->      April 24, 2013
June 2013      ->      May 22, 2013
July 2013      ->      June 26, 2013
August 2013      ->      July 24, 2013
September 2013      ->      August 28, 2013
October 2013      ->      September 25, 2013
November 2013      ->      October 23, 2013
December 2013      ->      November 20, 2013
January 2014      ->      December 18, 2013

2012 Schedule
For the month of      ->      Cheque issue date
January 2012      ->      December 21, 2011
February 2012      ->      January 25, 2012
March 2012      ->      February 22, 2012
April 2012      ->      March 21, 2012
May 2012      ->      April 25, 2012
June 2012      ->      May 23, 2012
July 2012      ->      June 27, 2012
August 2012      ->      July 25, 2012
September 2012      ->      August 29, 2012
October 2012      ->      September 26, 2012
November 2012      ->      October 24, 2012
December 2012      ->      November 21, 2012
January 2013      ->      December 19, 2012

2011 Schedule
For the month of      ->      Cheque issue date
January 2011      ->      December 15, 2010
February 2011      ->      January 19, 2011
March 2011      ->      February 16, 2011
April 2011      ->      March 23, 2011
May 2011      ->      April 20, 2011
June 2011      ->      May 18, 2011
July 2011      ->      June 22, 2011
August 2011      ->      July 27, 2011
September 2011      ->      August 24, 2011
October 2011     ->      September 21, 2011
November 2011      ->      October 26, 2011
December 2011      ->      November 23, 2011
January 2012      ->      December 21, 2011

2010 Schedule
For the month of Cheque issue date
January 2010      ->      December 16, 2009
February 2010      ->      January 20, 2010
March 2010      ->      February 17, 2010
April 2010      ->      March 24, 2010
May 2010      ->      April 21, 2010
June 2010      ->      May 19, 2010
July 2010      ->      June 23, 2010
August 2010      ->      July 21, 2010
September 2010      ->      August 25, 2010
October 2010      ->      September 22, 2010
November 2010      ->      October 27, 2010
December 2010      ->      November 24, 2010
January 2011      ->      December 15, 2010

Having five years of welfare cheque dates makes it a lot easier for researchers who are interested in tracking overdose deaths, police calls for service, medical emergencies, hospital admissions and so on.  However, despite my request for “all records associated with the change to public notification of cheque issue dates for the current year when prior to 2015, government made the past 5+ years of cheque issue dates available on its website,” no positive results came back when I got the Freedom of Information results. And so it appears there are no records whatsoever that document the decision of the previous provincial government to reduce the list of publicly available cheque dates from five years to only one year. This, in turn, limited the ability of researchers to analyze the potential harms of “cheque day.”

Testing street drugs for fentanyl: Does it reduce overdoses?

A pilot project by Insite that allows drug users to check their drugs for the presence of fentanyl has received a lot of publicity. Now, according to this article in the Globe & Mail, the BC government is going to increase the availability of these tests:

British Columbia is set to expand a program to allow people to check their street drugs for fentanyl, the latest harm-reduction initiative to roll out amid skyrocketing overdose deaths.

The most recent figures from the provincial government show 1,103 confirmed deaths from overdoses of illicit drugs in the first nine months of this year. The year-end total is on pace to be around seven times the annual average in the 2000s.

I’m going to take a few moments to explain why this harm-reduction strategy, in its current form, is a bad idea.

First, it is likely that cross-contamination is causing false positives. Insite is not a sterile lab environment, and nor are the drug users who are conducting these tests. Trace amounts of fentanyl and other opiates are likely present on their hands, clothes, etc. Only a very small amount of fentanyl is required to generate a positive test result.

Street drugs are often cut with a buffer, and the result is not a uniform mixture. For example, low-grade heroin cut with fentanyl has not been mixed to pharmaceutical standards. A tiny sample tested at Insite might have no fentanyl, but there could still be enough fentanyl in the remaining dose to kill the user. Also, the tests used by Insite result in false negatives. It’s also worth noting the tests can detect fentanyl, but may not be able to accurately or reliably detect other synthetic drugs such as W-18. The latter is known to be present in British Columbia. W-18 is orders of magnitude more toxic than fentanyl.

As mentioned the test itself, even if used correctly, inherently has a false negative rate. This means the test will sometimes come back negative even through fentanyl is present. Furthermore, the drug test strips were only designed to be used for human urine samples as a preliminary test. I obtained a copy of the BTNX Single Drug Test Strip from Kwan Tse, manager of QA / RA at BTNX Inc.  Excerpts from this product insert include numerous warnings (emphasis added by me).

In the section labeled INTENDED USE:

The Rapid Response Single Drug Test Strip is rapid chromatographic immunoassays for the qualitative and simultaneous detection of one of the following drugs in a variety of combinations in human urine.

This assay provides only a preliminary analytical test result. A more specific alternative chemical method must be used in order to obtain a confirmed analytical result.

In the section labeled QUALITY CONTROL:

Good laboratory practice recommends the use of control materials to ensure proper kit performance. Quality control specimens are available from commercial sources and are recommended to be used daily. Use the same assay procedure as with a urine specimen. Controls should be challenging to the assay cutoff concentration. If control values do not fall within established limits, assay results are invalid. Users should follow the appropriate federal, state, and local guidelines concerning the running of external quality controls.

There is no indication from Insite that control materials were used on a daily basis to ensure the validity of their off-label fentanyl screening tests. As such their test results are unreliable.

In the section labeled LIMITATIONS OF THE TEST:

The assay is designed for use with human urine only.

There is a possibility that technical or procedural error as well other substances as factors not listed may interfere with the test and cause false results. See SPECIFICITY for lists of substances that will produce either positive results, or that do not interfere with test performance.

In the section labeled Specificity:

The Specificity for the Rapid Response Single Drug Test Strip has been tested by adding various drugs, drug metabolites, and other compounds that are likely to be present in drug-free normal human urine. The Rapid Response Single Drug Test Strip performance at cutoff point are not affected when pH range of urine specimens is at 3.0 to 8.5 and specific gravity range of urine specimens is at near 1.005 to 1.03.

The specificity testing for this product was limited as the company was only considering what was likely to be found in drug-free human urine. It should be obvious by now that this product was never designed to be used for the testing of unknown street drugs prior to their consumption by humans.

The pilot project results obtained by Insite are compromised by these limitations. It is likely that various adulterants in street drugs as well as the drugs themselves are causing either false positives or false negatives.

There is also a risk that Insite is simply confirming the presence of fentanyl for drug traffickers whose true intention is to sell fentanyl on the streets. The data from the pilot project hints at this. Here is an excerpt from the abstract presented at the 2017 Harm Reduction International conference:

Of substances checked pre-consumption, compared to receiving a negative result, receiving a positive result did result in more dose reductions (37% vs. 8%) but not in more disposals (9% vs. 8%).

And so even when street drugs tested positive for fentanyl, the users did not get rid of their drugs.  The users said (to Insite staff) that they were reducing their planned dose, but there was no way to verify the truth of those statements. What the data shows is that clients walked out of Insite with their fentanyl-laced dope. Their likely plan was to sell their fentanyl to unsuspecting users, or to keep it for themselves and use it on their own.  Both choices have almost certainly resulted in fatal consequences for people who use drugs in British Columbia.

I have been a public advocate of harm reduction for almost a decade. But harm reduction supporters should not blindly accept every strategy and method put forward as harm reduction. Because the Insite pilot project did not result in users getting rid of their fentanyl, it cannot be said that testing street drugs for fentanyl actually reduces overdoses.

One last point: The data showing that users did not dispose of their fentanyl-laced drugs (once they become aware of the contamination) was never included in the original media release by Vancouver Coastal Health. I think it was an important point for journalists to know. Particularly as that media release generated worldwide coverage. Users and user-dealers were walking out the doors of Insite into the broader community, believing that the dope in their possession was fentanyl. It should have been in the original media release.

Disclaimer: The opinions expressed in this blog post represent my own personal views, and not those of my employer (or any other organization).